Winged Scapula==next steps

[mckinley rose]

On March 26,2006, I found I could not lift my right arm above approx.90 degrees. Scapula also winging out.  No pain, none whatsoever, including days weeks & months preceding onset, while lifting arm, or after onset. Events preceding onset: an arduous Yoga stretching class which focused shoulders and shoulder range of motion; this was followed by a 6 hour car trip, & upon arrival I came down with a vague virus--headache and fever and malaise which lasted two days. (My husband had this virus too.) When the malaise cleared I discovered this paralysis. I visited three doctors but none had heard of this condition and none took the problem seriously.  After self-diagnosing using the Internet I sought out a conscientious physical therapist who had heard of winged scapula/LTN condition, gave me exercises aimed at preventing further injury, and who put me in direct touch with a sports doctor (d.o.) who had heard of the condition (said he had heard of it in med school,that it was rare). He orderd EMG & MRI   & nerve conduct. study which verified the problem was with the long thoracic nerve & confirmed that nothing else was pressing against the nerve. Doctor told me to continue doing the exercises. Since then, I have continued most of my normal exercise (routine weight machines, treadmill, cycling, hiking and a reduced amount of running & jogging), quit yoga (can't do its most basic postures with this condition) and have done the P.T. exercises somewhat regularly. But there has been no discernible change to my paralysis, and it's been 9 months.  What should I do next? -Columbus

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
   The symptoms and story that you provide is consistent with long thoracic nerve injury, which may be due to one of several possible causes.  One possibility is stretching the nerve (or compressing the nerve against the inferior angle of bone) by extreme shoulder abduction (moving the arm/shoulder away from the body).  This can cause damage to the nerve and is common is some surgical procedures when the shoulder/arm is being manipulated to remove lymph nodes from the axillae (arm pit) for example.  It is theoretically possible that you stretched/compressed your nerve during your Yoga exercise.  Another possibility is called Neuralgic Amyotrophy, which is a condition that affects the LTN due to a poorly understood inflammatory condition (also called Parsonage-Turner syndrome).  In either case the prognosis of recovery depends of the extent of the injury.  Mild injuries cause a loss of the insulating cover of nerves (a process called demyelination) that generally recovers within 6 months or less.  More severe injuries involve the loss of axons (the 'wires' of nerves) and take longer to recover and may be permanent to some degree.  The degree of demyelination vs axon loss can be determined by EMG testing (in specialized centers) and thus a prognosis established.  I would suggest a repeat EMG to assess your status.  As far a treatment there is nothing except the exercises as you describe, unless you are having pain in which case then medications such as neurontin, lyrica, elavil etc. may be indicated.
I hope this has been helpful.

[miss_pippi]

A related discussion, winged scapula was started.

[mike1105]

it is possible you have stretched or in some way damaged your LTN. look up Dr. Raul Nath on the internet-- he specializes is LTN injuies/winging scapula. I believe he is in texas and on the website you can email him and he will respond.

[mckinley rose]

Yes, the imaging showed that the Long Thoracic Nerve is either compressed or demyelated or damaged in some way. Thanks for mentioning Dr. Nath. I have seen Dr. Nath's advertisements for his surgery, which he has performed 50 times, but I have been wary because advertising (and Nath's web site) are all I have to base my actions on.  Since I am originally from Cleveland I thought perhaps CC might have some experience or successes treating this condition--or professional knowledge of other experts with experience treating it.